Total Raised:
$56,062.00
If your company is interested in sponsoring
click here
.
SIGN UP TO SHOOT HOOPS
You must have JavaScript enabled in order to use this order form. Please enabled JavaScript and then reload order form in order to continue.
REGISTRATION INFORMATION
First Name:
Last Name:
Email:
Address:
City:
State/Prov:
Outside US & Canada
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip Code:
Phone:
LOGIN INFORMATION
We ask that you create a Username and Password. Our system provides the capability for you to collect donations from your friends and family online and view your donation collection status.
Username:
Password:
Re-Type Password:
PERSONAL CONNECTION
(optional)
If there is someone in whose honor or memory you wish to shoot, please indicate below:
In honor of
In memory of
Name:
DONATION INFORMATION
We encourage you to collect donations from your friends and family and now you can do it all online. Set your fundraising goal here so that they can help you reach your goal. It's up to you to decide how much you'll aim to raise. Just remember, you will be shooting hoops for a wonderful cause -- we bet you'll be able to meet, and probably exceed, any goal you set!
Amount:
You can jumpstart your fundraising today by making a personal donation:
I will not be making a donation at this time.
I would like to make a personal donation:
Amount:
Card Type:
VISA
MASTERCARD
AMEX
DISCOVER
Card Number:
Expiration Month:
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Year:
2007
2008
2009
2010
2011
Verification Code:
This is the 3 or 4 digit number printed on the back signature panel. It is on the front of the card for American Express.
Chai Lifeline is a non-profit 501c3 organization.
©2008 Hoops 4 Camp. All rights reserved.
Privacy Policy
Contact Us